IP - UR.1.renal_failure

CM Codes

Data Overview

15439 total codes in komodo_rii; 506 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	331
CC	139
MCC	36

PCA Analysis

PC1 explains 38.7% of variance; PC1+PC2 together explain 52.3%.

Tier Clustering (k=3)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	work rvu	n j code lines	transfusion	dialysis	icu
1	345.000	3540918.000	15.500	5.871	1.008	0.556	0.458	0.097	0.074	0.259
2	130.000	850331.000	16.864	7.159	1.263	0.736	0.642	0.185	0.140	0.309
3	31.000	119994.000	18.583	8.544	1.671	1.081	0.931	0.281	0.243	0.414

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	All
CC	84	47	8	139
MCC	4	17	15	36
No CC/MCC	257	66	8	331
All	345	130	31	506

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_relative_claim_charge	0.386	-0.125	0.426
avg_n_distinct_rev_codes	0.347	-0.095	0.285
rate_or	0.321	-0.092	0.290
avg_length_of_stay	0.309	-0.132	0.319
rate_transfusion	0.307	-0.048	0.366
rate_mechanical_ventilation	0.291	0.032	0.521
avg_n_j_code_lines	0.281	-0.125	0.233
rate_icu	0.264	0.120	0.327
rate_multiple_or_days	0.257	0.048	0.173
avg_work_rvu	0.254	-0.186	0.200
rate_dialysis	0.240	-0.014	0.184
avg_n_distinct_hcps	0.115	-0.177	-0.306
avg_n_imaging_lines	0.048	-0.104	0.081
avg_organ_system_count	-0.032	-0.214	-0.441

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 3, No CC/MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
I953	Hypotension of hemodialysis	No CC/MCC	7.901	3	976	dialysis (+2.10), length of stay (+1.18), relative claim charge (+0.95)
N250	Renal osteodystrophy	No CC/MCC	7.292	3	2196	n j code lines (+2.07), length of stay (+1.67), dialysis (+1.41)
Q2112	Patent foramen ovale	No CC/MCC	7.163	3	957	relative claim charge (+2.27), mechanical ventilation (+1.69), n j code lines (+1.61)
I517	Cardiomegaly	No CC/MCC	7.003	3	869	work rvu (+2.78), n j code lines (+2.54), multiple or days (+1.04)
K7031	Alcoholic cirrhosis of liver with ascites	No CC/MCC	4.662	3	2287	multiple or days (+1.49), or (+1.27), transfusion (+0.74)

Under-tiered: Tier 1, MCC (4 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1100	Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)	MCC	-1.494	1	911	icu (+0.79), or (-0.44), n distinct rev codes (-0.41)
E1010	Type 1 diabetes mellitus with ketoacidosis without coma	MCC	-0.877	1	1387	icu (+1.49), n distinct rev codes (-0.62), length of stay (-0.59)
U071	COVID-19	MCC	-0.627	1	8815	or (-0.27), length of stay (+0.21), icu (-0.15)
K8590	Acute pancreatitis without necrosis or infection, unspecified	MCC	0.153	1	2474	n j code lines (+0.25), length of stay (-0.17), icu (+0.15)

Top Codes by Tier

Tier 1 (n=345 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I5030	Unspecified diastolic (congestive) heart failure	CC	0.275	3247	work rvu (+0.39), n j code lines (+0.15), relative claim charge (-0.13)
C259	Malignant neoplasm of pancreas, unspecified	CC	0.251	1251	multiple or days (+0.66), work rvu (+0.24), or (+0.24)
K2970	Gastritis, unspecified, without bleeding	No CC/MCC	0.223	3654	work rvu (-0.27), n distinct rev codes (+0.25), n distinct hcps (+0.18)
B182	Chronic viral hepatitis C	No CC/MCC	0.207	2294	n j code lines (+0.24), multiple or days (+0.21), relative claim charge (-0.18)
C7802	Secondary malignant neoplasm of left lung	CC	0.204	1266	or (+0.31), transfusion (+0.30), multiple or days (-0.16)
C7951	Secondary malignant neoplasm of bone	CC	0.203	6820	transfusion (+0.35), or (+0.32), icu (-0.13)
Q613	Polycystic kidney, unspecified	CC	0.199	1100	dialysis (+0.64), n distinct rev codes (-0.35), multiple or days (+0.29)
K56600	Partial intestinal obstruction, unspecified as to cause	CC	0.180	888	work rvu (+0.44), n j code lines (+0.27), transfusion (-0.20)
C787	Secondary malignant neoplasm of liver and intrahepatic bile duct	CC	0.156	5580	or (+0.38), transfusion (+0.25), length of stay (-0.13)
K8590	Acute pancreatitis without necrosis or infection, unspecified	MCC	0.153	2474	n j code lines (+0.25), length of stay (-0.17), icu (+0.15)

Tier 2 (n=130 codes)

code	Description	CMS severity	Score	N claims	Key drivers
N186	End stage renal disease	MCC	3.966	37756	dialysis (+1.74), or (+0.58), n j code lines (+0.46)
L89154	Pressure ulcer of sacral region, stage 4	MCC	3.947	1034	relative claim charge (+0.90), length of stay (+0.81), transfusion (+0.77)
T380X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter	No CC/MCC	3.868	2161	or (+1.14), relative claim charge (+1.03), dialysis (+0.51)
K7469	Other cirrhosis of liver	No CC/MCC	3.848	1094	multiple or days (+1.16), or (+0.65), n j code lines (+0.54)
K269	Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation	No CC/MCC	3.789	849	n distinct rev codes (+0.88), multiple or days (+0.80), or (+0.51)
D61810	Antineoplastic chemotherapy induced pancytopenia	MCC	3.783	2319	transfusion (+1.47), relative claim charge (+0.61), n j code lines (+0.56)
E874	Mixed disorder of acid-base balance	CC	3.686	5084	icu (+0.78), relative claim charge (+0.77), mechanical ventilation (+0.74)
K766	Portal hypertension	CC	3.518	4511	or (+0.98), multiple or days (+0.71), transfusion (+0.62)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.480	4278	relative claim charge (+0.57), n distinct rev codes (+0.53), or (+0.36)
I8510	Secondary esophageal varices without bleeding	CC	3.447	1564	or (+1.09), multiple or days (+0.88), transfusion (+0.75)

Tier 3 (n=31 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9602	Acute respiratory failure with hypercapnia	MCC	11.191	2612	mechanical ventilation (+3.08), relative claim charge (+1.90), icu (+1.50)
K264	Chronic or unspecified duodenal ulcer with hemorrhage	MCC	9.107	835	transfusion (+1.90), relative claim charge (+1.65), n distinct rev codes (+1.59)
J690	Pneumonitis due to inhalation of food and vomit	MCC	9.086	5310	mechanical ventilation (+1.80), relative claim charge (+1.78), n distinct rev codes (+1.32)
K7200	Acute and subacute hepatic failure without coma	MCC	8.837	1878	mechanical ventilation (+2.18), relative claim charge (+1.79), icu (+1.18)
A419	Sepsis, unspecified organism	MCC	8.498	8125	mechanical ventilation (+1.37), relative claim charge (+1.25), n distinct rev codes (+0.90)
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	8.411	1134	mechanical ventilation (+2.62), work rvu (+1.29), icu (+0.89)
I953	Hypotension of hemodialysis	No CC/MCC	7.901	976	dialysis (+2.10), length of stay (+1.18), relative claim charge (+0.95)
N250	Renal osteodystrophy	No CC/MCC	7.292	2196	n j code lines (+2.07), length of stay (+1.67), dialysis (+1.41)
Q2112	Patent foramen ovale	No CC/MCC	7.163	957	relative claim charge (+2.27), mechanical ventilation (+1.69), n j code lines (+1.61)
D684	Acquired coagulation factor deficiency	CC	7.154	843	relative claim charge (+1.25), or (+1.07), transfusion (+1.02)

Key Driver Frequency

feature	count	pct
relative claim charge	244	48.200
n distinct rev codes	236	46.600
or	189	37.400
length of stay	176	34.800
n j code lines	131	25.900
icu	129	25.500
transfusion	123	24.300
multiple or days	109	21.500
work rvu	91	18.000
dialysis	38	7.500
mechanical ventilation	28	5.500
n distinct hcps	22	4.300
n imaging lines	2	0.400

PCS Codes

Data Overview

3263 total codes in komodo_rii; 61 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 46.5% of variance; PC1+PC2 together explain 59.7%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	relative claim charge	work rvu	n j code lines	mechanical ventilation	organ system count	icu
1	8.000	15289.000	14.125	5.488	1.015	0.230	0.380	0.011	5.206	0.216
2	30.000	108368.000	18.663	7.593	1.645	0.619	0.643	0.025	5.407	0.337
3	17.000	37200.000	21.049	9.683	2.366	0.688	0.703	0.175	5.630	0.509
4	6.000	9695.000	22.760	10.926	3.699	1.524	1.296	0.631	5.820	0.779

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_relative_claim_charge	0.354	-0.043
avg_n_distinct_rev_codes	0.346	0.020
rate_icu	0.324	-0.047
avg_length_of_stay	0.317	-0.034
avg_work_rvu	0.315	-0.071
avg_n_j_code_lines	0.294	-0.147
rate_mechanical_ventilation	0.271	-0.074
rate_multiple_or_days	0.252	0.104
avg_organ_system_count	0.245	0.190
rate_transfusion	0.231	0.148
rate_dialysis	0.193	0.117
avg_n_imaging_lines	0.190	-0.175
rate_or	0.174	0.168
avg_n_distinct_hcps	0.101	0.096

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=8 codes)

code	Description	Score	N claims	Key drivers
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	-3.093	1250	n distinct rev codes (-0.56), length of stay (-0.50), relative claim charge (-0.35)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-3.387	1082	n distinct rev codes (-0.45), length of stay (-0.44), relative claim charge (-0.41)
0T9B70Z	DRAINAGE OF BLADDER WITH DRAINAGE DEVICE, VIA NATURAL OR ARTIFICIAL OPENING	-3.541	4929	n distinct rev codes (-0.69), organ system count (-0.35), relative claim charge (-0.34)
8E0ZXY6	ISOLATION	-3.684	2894	n distinct rev codes (-0.64), work rvu (-0.42), length of stay (-0.34)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.863	1677	n distinct rev codes (-0.59), icu (-0.45), work rvu (-0.42)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.591	1274	n distinct rev codes (-0.77), length of stay (-0.47), organ system count (-0.47)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.890	1316	n distinct rev codes (-0.79), icu (-0.59), length of stay (-0.51)
3E013GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO SUBCUTANEOUS TISSUE, PERCUTANEOUS APPROACH	-4.904	867	n distinct rev codes (-0.79), work rvu (-0.53), length of stay (-0.52)

Tier 2 (n=30 codes)

code	Description	Score	N claims	Key drivers
0DJ08ZZ	INSPECTION OF UPPER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	0.196	3882	transfusion (+0.22), organ system count (+0.20), icu (-0.17)
5A09457	ASSISTANCE WITH RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	0.022	1188	n j code lines (+0.42), icu (+0.20), n imaging lines (-0.18)
0DJD8ZZ	INSPECTION OF LOWER INTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	-0.057	2036	transfusion (+0.30), organ system count (+0.25), icu (-0.19)
4A10X4Z	MONITORING OF CENTRAL NERVOUS ELECTRICAL ACTIVITY, EXTERNAL APPROACH	-0.087	1299	n imaging lines (+0.62), multiple or days (-0.31), or (-0.18)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	-0.255	2730	multiple or days (+0.48), n j code lines (-0.24), icu (-0.24)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-0.318	19848	transfusion (+0.83), n imaging lines (-0.18), n j code lines (-0.15)
05HY33Z	INSERTION OF INFUSION DEVICE INTO UPPER VEIN, PERCUTANEOUS APPROACH	-0.414	2377	multiple or days (+0.43), n distinct hcps (-0.23), relative claim charge (-0.14)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	-0.441	4800	multiple or days (+0.40), or (+0.24), n imaging lines (-0.20)
0T9130Z	DRAINAGE OF LEFT KIDNEY WITH DRAINAGE DEVICE, PERCUTANEOUS APPROACH	-0.566	1072	organ system count (-0.46), or (+0.31), icu (-0.21)
0TB03ZX	EXCISION OF RIGHT KIDNEY, PERCUTANEOUS APPROACH, DIAGNOSTIC	-0.574	1723	or (+0.30), icu (-0.26), organ system count (-0.23)

Tier 3 (n=17 codes)

code	Description	Score	N claims	Key drivers
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	2.596	2899	dialysis (+0.52), n distinct hcps (+0.37), n distinct rev codes (+0.36)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	2.027	1302	mechanical ventilation (+0.97), multiple or days (+0.48), icu (+0.41)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	1.908	1177	n imaging lines (+0.86), n distinct rev codes (+0.40), relative claim charge (+0.39)
5A12012	PERFORMANCE OF CARDIAC OUTPUT, SINGLE, MANUAL	1.787	862	mechanical ventilation (+0.48), icu (+0.31), multiple or days (+0.30)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	1.758	1883	icu (+0.34), dialysis (+0.31), length of stay (+0.25)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	1.738	13710	icu (+0.31), dialysis (+0.29), n distinct rev codes (+0.25)
3E0G76Z	INTRODUCTION OF NUTRITIONAL SUBSTANCE INTO UPPER GI, VIA NATURAL OR ARTIFICIAL OPENING	1.679	1417	length of stay (+0.73), work rvu (+0.42), relative claim charge (+0.27)
0W3P8ZZ	CONTROL BLEEDING IN GASTROINTESTINAL TRACT, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC	1.463	1138	transfusion (+0.51), organ system count (+0.40), n distinct rev codes (+0.38)
30233R1	TRANSFUSION OF NONAUTOLOGOUS PLATELETS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	1.427	900	transfusion (+0.84), relative claim charge (+0.34), length of stay (+0.22)
0DH63UZ	INSERTION OF FEEDING DEVICE INTO STOMACH, PERCUTANEOUS APPROACH	1.414	1399	length of stay (+0.98), n distinct rev codes (+0.40), relative claim charge (+0.19)

Tier 4 (n=6 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	8.116	1104	relative claim charge (+1.82), length of stay (+1.06), work rvu (+1.04)
5A1D90Z	PERFORMANCE OF URINARY FILTRATION, CONTINUOUS, GREATER THAN 18 HOURS PER DAY	5.813	1127	icu (+0.78), n j code lines (+0.71), work rvu (+0.70)
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	5.393	1536	mechanical ventilation (+0.97), icu (+0.71), n j code lines (+0.64)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	4.850	1469	work rvu (+0.74), icu (+0.71), multiple or days (+0.58)
3E043XZ	INTRODUCTION OF VASOPRESSOR INTO CENTRAL VEIN, PERCUTANEOUS APPROACH	4.546	1134	work rvu (+0.94), n j code lines (+0.83), icu (+0.76)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.437	3325	mechanical ventilation (+0.82), relative claim charge (+0.77), icu (+0.52)

Key Driver Frequency

feature	count	pct
icu	30	49.200
n distinct rev codes	23	37.700
organ system count	17	27.900
n j code lines	16	26.200
length of stay	14	23.000
relative claim charge	14	23.000
multiple or days	13	21.300
work rvu	13	21.300
n imaging lines	10	16.400
or	9	14.800
transfusion	9	14.800
dialysis	8	13.100
mechanical ventilation	4	6.600
n distinct hcps	3	4.900